Political Event Protest Incident Report Form
Use this form to report and document incidents that occurred during a political protest event.
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Your Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Protest Event
*
-
Month
-
Day
Year
Date
Location of Protest Event (address or description)
*
Time of Incident (if known)
Hour Minutes
AM
PM
AM/PM Option
Type of Incident
*
Please Select
Physical altercation
Property damage
Arrest or detention
Use of force by authorities
Medical emergency
Verbal confrontation
Other
Please describe the incident in detail
*
Persons directly involved (if known)
Were there any witnesses?
*
Yes
No
If yes, please list witness names and contact information (if known)
Have you reported this incident to any authorities?
*
Yes
No
Please upload any supporting evidence (photos, videos, documents)
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